This application addresses broad Challenge Area (15) Translational Science and specific Challenge Topic (15-MH-105) Strategies to Support Uptake of Interventions within Clinical Community and Settings. Implementation of evidence-based treatments into mental health service settings is a major priority for improving the quality of services and outcomes for patients. Studies of strategies to promote evidence-based practices among VA PTSD treatment providers are an urgent necessity due to influx of over a million soldiers returning from wars in Iraq and Afghanistan and a recent unexpected flood of Vietnam Veterans entering treatment. If inadequately treated, PTSD can become a chronic disorder contributing to substantial psychological and physical impairments, as well as social and occupational disabilities. This application proposes to evaluate two national roll- outs of evidence-based treatments in Department of Veterans Affairs (VA) residential Posttraumatic Stress Disorder (PTSD) treatment programs (N= 40) within a theory-driven, empirically-based, multi-level dissemination and implementation framework. The overarching goal is to characterize and assess the implementation process of the two evidenced-based psychotherapies for PTSD, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). The investigation will measure contextual factors likely to impact implementation, with particular emphasis placed on clinicians'perceived characteristics of the therapies, environmental support, social networks and peer opinion leaders. The proposed study will be conducted in partnership with the Northeast Program Evaluation Program (NEPEC), which monitors all VA mental health programming nationwide, and the National Center for PTSD (NC-PTSD), which oversees the dissemination of PE and CPT nationally among VA providers. We plan to extend the dissemination program evaluation efforts of the NC-PTSD by adding quantitative and qualitative assessments of over 250 mental health providers in residential PTSD treatment settings through online self-administered questionnaires, semi-structured interviews and on-site observation. Implementation outcomes will include full, partial and modified adoption by programs and individual providers, as well as patient outcomes. Capitalizing on existing NEPEC patient outcome monitoring, the effect of implementation of PE and CPT can be examined in terms of Veterans'PTSD symptoms, substance abuse, violent behavior, employment and satisfaction with treatment. This application proposes to examine roll-outs of two evidence-based psychotherapies, Prolonged Exposure and Cognitive Processing Therapy, in Department of Veterans Affairs (VA) residential Posttraumatic Stress Disorder (PTSD) treatment programs (N= 40) within a theory-driven, empirically-based, multi-level dissemination and implementation framework. The VA is the nation's largest health care organization. Studying the process and outcome of PE and CPT implementation in VA practice is an urgent public health necessity and likely has the potential to advance knowledge about effective implementation strategies for improving the uptake of evidence-based treatments in other federally-funded mental health systems.